Healthcare Provider Details

I. General information

NPI: 1114911286
Provider Name (Legal Business Name): ORTHOPEDIC CONSULTANTS PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 NICHOLASVILLE RD SUITE 604
LEXINGTON KY
40503-1471
US

IV. Provider business mailing address

1760 NICHOLASVILLE RD SUITE 604
LEXINGTON KY
40503-1471
US

V. Phone/Fax

Practice location:
  • Phone: 859-255-9059
  • Fax: 859-254-3112
Mailing address:
  • Phone: 859-255-9059
  • Fax: 859-254-3112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number10622001
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA009
License Number StateKY

VIII. Authorized Official

Name: DR. JOHN J VAUGHAN
Title or Position: PRESIDENT
Credential:
Phone: 859-255-9059